Surgery and antibiotics for the treatment of lupus nephritis with cerebral abscesses: A case report

Table 1 History of diagnosis in the past year

Diagnosis items	Result
Symptoms	Eyelid and facial edema with skin tightening sensation, pain in multiple joints, hair loss, reduced urine volume, and facial photoallergy
Laboratory tests	Urine protein: Positive (+++), WBC: 3.5 × 109/L; Total platelet count: 40x109/L; Albumin: 21.7 g/L; Creatinine: 149 μmmol/L; Thyroid function: Serum free T3: 1.9 pmol, serum free T4: 8.1 pmol/L; Anti-nuclear antibody profile: ANA positive (1:320 fine granular type), RNP/sm: Positive (+), SSA: Positive (+++), RO-52: Positive (+++), SSB: Positive (+++), anti-nucleosome antibody: Positive (++), anti-ribosomal P protein antibody: Positive (++); Complement C3: 0.3 g/L
Bone marrow cell test	Bone marrow cell test showed: Accelerated granulocyte maturation and active plasma cells
Pathological biopsy	Class IV-G lupus nephritis
Diagnosis	Class IV-G lupus nephritis; SLE (involving the hematologic system and organs) SLEDAI score 11; Subclinical hypothyroidism; Acute renal insufficiency

SLE: Systemic lupus erythematosus; SLEDAI: Systemic lupus erythematosus disease activity index.

Table 2 History of treatment in the past year

Date	Treatment		Drug-specific
Treatment (April-December 2017)	Phase 1	Primary treatment	Methylprednisolone shock therapy (500 mg/d/3D)/hemodialysis 5 times, once every other day (due to progressive increase in serum creatinine to 455 μmol/L)/intravenous immunoglobulin
		Adjuvant treatment	Symptomatic treatments to control infection/supplement albumin and supplement thyroxine
	Phase 2	Primary treatment	Prednisone 60 mg/d QD maintenance/cyclophosphamide shock therapy (European protocol)
		Adjuvant treatment	Infection control/platelet infusion
After discharge (December 2017 – April 2018)	Primary treatment		Oral prednisone 40 mg/d, outpatient follow-up, monthly gradually reduced to 20 mg/d/oral MMF 1.5 g bid
Return for treatment due to lung infection (April 2018)	Primary treatment		The prednisone and MMF schemes remained unchanged /Immunomodulatory and anti-infective therapy for lung infection
After discharge(April-May 2018)	Primary treatment		Oral prednisone 20 mg/d/ oral MMF 1.0 g bid
June 2018	Admitted to hospital due to multiple brain abscesses

MMF: Mycophenolate mofetil.

Table 3 Patient outcome after receiving surgery and anti-infective treatment

	At admission	Before surgery	4 d post-surgery	3 d post-antibiotic adjustment	3 wk post-multi-antibiotic treatment
White blood cell (109/L)	12.34	6.26	5.23	6.54	3.73
Percentage of neutrophils (Neu%)	83.60	75.40	73.60	71.90	70
High-sensitivity C-reactive protein (mg/L)	18.85	20.3	6.19	25.99	< 0.499
Creatinine (CREA, umol/L)	233	193	198	166	158
Urea nitrogen (BUN, mmol/L)	14.9	10.7	11.2	10.8	9.4

Table 4 Indices of lupus nephritis and infection after 2 years follow-up

Date	WBC (109/L)	Neu (%)	RBC (1012/L)	HGB (g/L)	PLT (109/L)	ALB (g/L)	AST (U/L)	ALT (U/L)	BUN (mmol/L)	CREA(μmol/L)	eGFR (mL/min)	24 h PRO in urine (mg/24h)	C3 (g/L)	C4 (g/L)	ESR (mm/h)	CD4/CD8
November 11, 2018	5.14	75.1	1.75	53	79	22.7	45	123	22.29	185	41.95	3131	0.46	0.21	7	0.31
December 16, 2018	5.0	66.8	3.47	103	157	36.7	23	26	6.76	67	80.74	3684	0.93	0.25	28	/
March28, 2019	5.26	62	3.48	104	153	41.1	27	27	5.85	76	77.73	1409	0.98	0.25	36	/
May 23, 2019	5.51	66.2	3.72	110	184	43.6	27	26	6.49	83	77.46	1479	1.05	0.29	25	/
September 29, 2019	6.05	63.2	3.89	115	114	41.8	25	38	6.50	70	78.27	1051	1.23	0.29	16	/
November 21,2019	5.93	61.9	3.54	111	175	48.3	20	24	7.00	74	73.81	1173	1.20	0.28	19	/
January 23, 2020	6.61	64.1	3.88	119	187	43.8	22	23	6.36	61	79.87	700	1.19	0.29	19	/
April 2,2020	7.31	64.4	4.16	126	186	45.9	21	22	6.92	61	81.08	1204	1.21	0.30	23	/
September 27, 2020	6.02	59.6	4.23	125	195	44.3	24	29	6.43	65	84.03	586	1.04	0.35	19	0.88

HGB: Hemoglobin; PLT: Platelets; ALB: Albumin; AST: Aspartate transaminase; ALT: Alanine transaminase; BUN: Blood urea nitrogen; CREA: Creatinine; eGFR: Estimated glomerular filtration rate; PRO: Protein; C3: Complement 3; C4: Complement 4.